Department of Public
Health
Guide to New and Current
MassHealth Behavioral
Health Services
&
Early Intervention Program
Protocols
Table of Contents
Section 1
MassHealth: New and Current Services
Pg 3
Section 2
Department of Public Health-Early Intervention
Protocols
Pg 15
Section 1
MassHealth: New and
Current Services
I.
Section 1
MassHealth: New and
Current Services
I. The Children’s Behavioral Health Initiative (CBHI)
The Children’s Behavioral Health Initiative is an interagency initiative of the Commonwealth’s
Executive Office of Health and Human Services whose mission is to strengthen, expand and
integrate Massachusetts state services into a comprehensive, community-based system of care, to
ensure that families and their children with significant behavioral, emotional and mental health
needs obtain the services necessary for success in home, school and community.
The Children’s Behavioral Health Initiative is defined by a shared commitment to providing
services to families that reflect the following values:
* Family Driven, Child-Centered and Youth Guided
Services are driven by the needs and preferences of the child and family, developed in
partnership with families and accountable to families.
* Strengths-based
Services are built on the strengths of the family and their community
* Culturally Responsive
Services are responsive to the family’s values, beliefs, norms, and to the socio-economic
and cultural context.
* Collaborative and Integrated
Services are integrated across child-serving agencies and programs.
* Continuously Improving
Service improvements reflect a culture of continuous learning, informed by data, family
feedback, evidence and best practice.
The Initiative places the family and child at the center of our service delivery system, and will build
an integrated system of behavioral health services that meets the individual needs of the child and
family. The goal is to make it easier for families to find and access appropriate services and to
ensure that families feel welcome, respected and receive services that meet their needs, as defined
by the family.
For more information visit: www.mass.gov/masshealth/childbehavioralhealth
II. MassHealth: New and Current Services
MassHealth pays for many important health care services for a wide range of people who meet the
eligibility rules. In 2009, MassHealth significantly expanded behavioral health services available to
its MassHealth Standard and CommonHealth members under the age of 21 by paying for six new
home and community-based services. The goal of these services is to help children and youth with
significant behavioral, emotional and mental health needs achieve success in home, school and
community.
These services have been designed, and are being implemented according to Children’s Behavioral
Health Initiative Values:
* Family Driven, Child-Centered and Youth Guided
* Strengths-based
* Culturally Responsive
* Collaborative and Integrated
* Continuously Improving
These new services complement the behavioral health services currently available to MassHealth
Standard and CommonHealth members under the age of 21. Below, you will find brief
descriptions of the new services, and of the current community-based MassHealth Behavioral Health
Services.
NOTE: These new services are NOT for the treatment of the behavioral health needs of a youth’s
parents or caregivers. Behavioral Health services for parents or caregivers should be sought
through their health care insurer, or MassHealth, if they are eligible.
New MassHealth Community-Based Behavioral Health Services
What follows are brief descriptions of the new services, with some suggestions of who might
benefit from each of the new services.
This information is intended to provide staff with guidance on how to help families and youth to
access appropriate MassHealth behavioral health services. It is important to note that MassHealth
members may also self-refer to any behavioral health service they think might be helpful. Families
and youth are always welcome to inquire with a provider about a particular service.
This guidance is intended to be informative and to illustrate the potential usefulness of each
service. It does NOT replace the Medical Necessity Criteria, attached in Appendix B. Providers of
each of the services will use the Medical Necessity Criteria (MNC) to evaluate whether the child
or youth has a medical need for the service. Medical Necessity decisions made by providers may
be reviewed by the child’s or youth’s MassHealth Managed Care Plan.
A. Standardized Behavioral Health Screening in Primary Care
As part of well-child visits, the primary care doctor or nurse checks the child’s or youth’s health,
development, need for immunizations, dental health and behavioral health. MassHealth now
requires primary care doctors or nurses to offer to use a behavioral health screening tool to
check the child’s or youth’s behavioral health. There are eight approved screening tools. They
typically consist of a short list of questions, or a checklist, that the parent, caregiver or youth fills
out and then talks about with the primary care doctor or nurse. The screening tool helps to spot
concerns early so problems can be found and helped earlier. If there are concerns about a child’s
or youth’s behavioral health, the primary care doctor or nurse will work with the parent/caregiver
or youth to decide if a referral to a behavioral health provider for further assessment and
treatment is needed, and can help the parent/caregiver/youth get needed services.
B. Standardized Behavioral Health Assessment, using the Child Adolescent Needs and
Strengths tool (CANS)
Beginning November 30, 2008, MassHealth began requiring a uniform behavioral health assessment
process for MassHealth members under the age of 21 receiving behavioral health services. The
uniform behavioral health assessment process includes a comprehensive needs assessment using
the Child and Adolescent Needs and Strengths (CANS) tool.
The CANS is a tool that organizes clinical information collected during a behavioral health
assessment in a consistent manner, to improve communication among those involved in planning
care for a child or youth. The CANS is also used as a decision-support tool to guide care planning,
and to track changing strengths and needs over time. The CANS is used in child and youth serving
systems in more than 30 states. There are two forms of the Massachusetts CANS: CANS Birth
through Four and CANS Five through Twenty. Both versions include questions that enable the
assessor to determine whether a child meets the criteria for Serious Emotional Disturbance
(SED), in addition to the CANS assessment questions. (Meeting the definition of SED is a
component of the Medical Necessity Criteria for the new service Intensive Care Coordination.)
C. Intensive Care Coordination (starting June 30, 2009)
ICC is a care coordination service for children and youth with serious emotional disturbance (For
definitions of Serious Emotional Disturbance, see ICC Medical Necessity Criteria, Appendix B).
ICC will use a model called Wraparound Care Planning. In Wraparound Care Planning, families and
youth work together with professionals, talk about their strengths and needs, and actively guide
their own care. In ICC, a team leader, called a Care Coordinator, helps families bring together a
team of people to create a child’s treatment plan. This Care Planning Team often includes
therapists, teachers, social workers and representatives of all child-serving agencies involved with
the youth. It also includes “natural supports”, such as family members, friends and people from
the family’s neighborhood or community that the family invites to be part of the team. Together,
the team comes up with ways to support the family’s goals for the child (or youth’s goals, in the
case of an older child), creating an Individual Care Plan. This plan, which also focuses on the
family’s strengths and respects their cultural preferences, lists all the behavioral health, social,
therapeutic or other services needed by the child and family including informal and community
resources. It will guide the youth’s care and involve all providers and state agencies to integrate
services.
The Care Planning Team will usually meet monthly and sometimes more often for children and
youth with more complex needs. At these meetings the family, youth and other team members
can talk about progress, work to solve problems, and make any needed changes to the Individual
Care Plan.
Additionally the ICC care planning team seeks to:
* Help the family obtain and coordinate services the youth needs and/or receives from
providers, state agencies, special education, or a combination thereof
* Assist with access to medically necessary services and ensure these services are provided
in a coordinated manner
* Facilitate a collaborative relationship among a youth with SED, his/her family, natural
supports, and involved child-serving systems to support the parent/caregiver in meeting
their youth’s needs
Who is likely to need ICC?
Children and families who need or receive services from multiple providers or who need or
receive services from multiple state agencies, including special education. ICC can help prioritize
goals and monitor progress, ensuring that interventions being used are effective and coordinated.
ICC can also address needs other than behavioral health needs, such as connecting families with a
variety of sustainable supports. Examples of sustainable supports include recreational activities for
the child or youth, connection to mentors and opportunities for mutual support and social
interaction with other families.
Who may benefit from referral to a different service?
> A child or youth in acute emotional, behavioral or mental health crisis. Consider referring instead
to Mobile Crisis Intervention for immediate stabilization and support.
> Family of a child or youth with a single service need who does not need a Care Planning Team to
coordinate services: Consider referring instead to the service(s) that may be needed.
> A family in too much immediate distress to participate in the team-based sequence of steps of the
Wraparound process. Consider referring first to another behavioral health service such as
Family Stabilization Teams (until November 1, 2009) or In-home Therapy (available
November 1 2009, during which the need for other services including ICC will be
assessed).
How do I make a referral?
See the list of Community Service Agencies in Appendix A.
Geographically-Based CSAs: MassHealth’s Managed Care Contractors have selected 29
Community Service Agencies (CSAs), one for each of 29 service areas. The service areas
correspond to the Areas of the Department of Children and Families.
Culturally and Linguistically Specialized CSAs: MassHealth’s Managed Care Contractors
have also selected 3 culturally and linguistically specialized CSAs. These CSAs were chosen for
their demonstrated ability to reach deeply in to specific cultural or linguistic communities and
tailor their services to engage and serve their specified populations. Like all CSAs, Specialized
CSAs are expected to serve any family seeking appropriate service without regard to race,
ethnicity or language.
o Children’s Services of Roxbury specializes in serving the African-American population in
Greater Boston.
o The Gandara Center specializes in serving the Latino population in the Springfield/Holyoke
area.
o The Learning Center for the Deaf, Walden School specializes in serving the Deaf and Hard
of Hearing population, particularly in the eastern/central part of the state.
Families with children or youth enrolled in MassHealth are not required to choose a CSA in their
area or a culturally or linguistically specialized CSA, but may choose to work with any CSA.
For more specific information about how to access these services on behalf of a youth enrolled in
a MassHealth managed care plan contact the plan directly. Contact numbers for the plans are
listed at the end of this section.
D. In-Home Therapy (starting November 1, 2009)
In-Home Therapy Services provides intensive family therapy for a child and family for the purpose
of treating the youth’s behavioral health needs, including improving the family’s ability to provide
effective support for the youth to promote his/her healthy functioning within the family. In-Home
Therapy Services are provided in the home or other location which is appropriate and convenient
to the family. It is provided by a skilled behavioral health provider who may work in a team with a
paraprofessional. In-Home Therapy providers work to understand how the family functions
together and how these relationships can be strengthened to benefit the child. Together with the
child and family, they create and implement a treatment plan. Goals in a treatment plan might
include helping the family identify and use community resources, learn to more effectively set
limits and establish helpful routines for their child, problem-solve difficult situations or change
family behavior patterns that get in the way of their child’s success. Note: Parents may also have
individual behavioral health needs that may require separate behavioral health treatment.
Who is likely to need In-Home Therapy?
> Families in need of more urgent or intensive help with a youth’s emotional and behavioral challenges
than could be addressed through outpatient therapy.
> Families that have identified their primary need as learning new ways to relate to one another, or new
ways to set limits or regulate child behavior, or who have tried outpatient therapy but not found it
effective. IHT offers more flexibility than outpatient therapy, not only in intensity but in
treatment setting. Therapeutic intervention in a natural environment can offer opportunities
for understanding behavior and for rehearsing new strategies which are not available in a
clinic environment.
Who may benefit from referral to a different behavioral health service?
> A child or youth in acute crisis. Consider referral to Mobile Crisis intervention.
> Children and families with needs involving multiple providers or state agencies. Consider referral to
ICC.
> A child with a disorder that can benefit from outpatient individual or family treatment.
How do I make a referral?
Referrals can be made directly to the In-Home provider or the child may access In-Home therapy
through ICC or outpatient therapy.
For more specific information about how to access these services on behalf of a youth enrolled in
a MassHealth managed care plan contact the plan directly. Contact numbers for the plans are
listed at the end of this section.
For a list of the common network of In-Home providers selected by all MassHealth’s Managed
Care entities, see Appendix A. For additional providers selected for MBHP’s “extended network”,
also see Appendix A. The most up-to-date information on the In-Home Therapy provider
network can also be found on the website of the appropriate MassHealth Managed Care entity or
by calling the Managed Care entity.
E. Mobile Crisis Intervention (starting June 30, 2009)
Mobile Crisis Intervention is the youth (under the age of 21) -serving component of an emergency
service program (ESP) provider. Mobile Crisis Intervention will provide a short-term service that
is a mobile, on-site, face-to-face therapeutic response to a youth experiencing a behavioral health
crisis for the purpose of identifying, assessing, treating, and stabilizing the situation and reducing
immediate risk of danger to the youth or others consistent with the youth’s risk
management/safety plan, if any. This service is provided 24 hours a day, 7 days a week.
The service includes: A crisis assessment; development of a risk management/safety plan, if the
youth/family does not already have one; up to 72 hours of crisis intervention and stabilization
services including: on-site face-to-face therapeutic response, psychiatric consultation and urgent
psychopharmacology intervention, as needed; and referrals and linkages to all medically necessary
behavioral health services and supports, including access to appropriate services along the
behavioral health continuum of care.
For youth who are receiving Intensive Care Coordination (ICC), Mobile Crisis Intervention staff
will coordinate with the youth’s ICC care coordinator throughout the delivery of the service.
Mobile Crisis Intervention also will coordinate with the youth’s primary care physician, any other
care management program or other behavioral health providers providing services to the youth
throughout the delivery of the service.
Who is likely to benefit?
A child with MassHealth who is in a behavioral health crisis and who is likely, without intervention,
to escalate in a way that would pose a risk of harm to themselves or others. If in doubt, call the
Mobile Crisis Intervention team and consult with the team on whether they should intervene.
Who may benefit from a different service?
If a child is in treatment he or she may have a Risk Management/Safety Plan which may identify other
steps prior to calling Mobile Crisis.
Note that Mobile Crisis Intervention is only for a child/youth on MassHealth. A person who does not
have MassHealth should be triaged through the 800 number on the back of the health insurance
card or sent to the local emergency services program or hospital emergency room.
If the child/youth is an acute safety risk to self or others and the risk cannot be safely managed in the
current setting, call 911.
How do I make a referral?
Mobile Crisis Intervention is provided by the Emergency Service Provider (ESP) in the region. See
the list of ESPs in Appendix A.
F. Additional new MassHealth-covered services can be accessed through outpatient
therapy, In-Home therapy or Intensive Care Coordination, as part of the youth’s
Individual Care Plan (ICP) or treatment plan (for Outpatient or In-Home
Therapy).
> Family Support and Training (Starting June 30, 2009)
Family Support and Training is a service that provides a structured, one-to-one, strength-based
relationship between a Family Support and Training Partner and a parent/caregiver. The purpose
of this service is for resolving or ameliorating the youth’s emotional and behavioral needs by
improving the capacity of the parent /caregiver to parent the youth so as to improve the youth’s
functioning as identified in the outpatient or In-Home Therapy treatment plan or Individual Care
Plan (ICP), for youth enrolled in Intensive Care Coordination (ICC), and to support the youth in
the community or to assist the youth in returning to the community.
Services may include education, assistance in navigating the child serving systems (child welfare,
education, mental health, juvenile justice, etc.); fostering empowerment, including linkages to
peer/parent support and self-help groups; assistance in identifying formal and community resources
(e.g., after-school programs, food assistance, summer camps, etc.) support, coaching, and training
for the parent/caregiver.
In ICC, the care coordinator and Family Support and Training Partner work together with youth
with SED and their families while maintaining their discrete functions. The Family Support and
Training Partner works one-on-one and maintains regular frequent contact the
parent(s)/caregiver(s) in order to provide education and support throughout the care planning
process, attends CPT meetings, and may assist the parent(s)/ caregiver(s) in articulating the youth’s
strengths, needs, and goals for ICC to the care coordinator and CPT. The Family Support and
Training Partner educates parents/ caregivers about how to effectively navigate the child-serving
systems for themselves and about the existence of informal/community resources available to
them; and facilitates the parent’s/caregiver’s access to these resources. Family Partners
are offered to families as part of Intensive Care Coordination.
> In-Home Behavioral Health Services – Starting October 1, 2009
In-Home Behavioral Health Services offers valuable support to children and youth with challenging
behaviors that get in the way of everyday life. Services are provided by a behavioral health
provider, such as a therapist, who is skilled in understanding and treating difficult behaviors in
children and youth. The provider works closely with the child and family to create a specific
behavior plan to improve the child’s functioning. The provider may also work as a team with a
skilled paraprofessional called a behavioral management monitor. The monitor works with the
child and family to implement the child’s behavior plan. In-Home Behavioral Health Services can
be provided in places where the child is located, including home, school, childcare centers and
other community settings.
> Therapeutic Mentoring Services – Starting October 1, 2009
A therapeutic mentor works one-on-one with a child or youth who, because of their behavioral
health needs, require support and coaching to learn social skills that will allow them to do well in
typical, normative environments. These skills may include better ways of communicating with
other children and adults, dealing with different opinions and getting along with others. The
therapeutic mentor works with the child to achieve goals in a treatment plan written by an
outpatient therapist, In-Home Therapy Services provider or Intensive Care Coordination (ICC)
team. The mentor is supervised by a behavioral health clinician and can work with a child in his or
her home, school, or other social and recreational setting.
For families and youth who may need or benefit from these services, social workers should
consider facilitating a referral process with the out-patient provider, in-home therapist, or ICC
team.
For more specific information about how to access these services on behalf of a youth enrolled in
a MassHealth managed care plan contact the plan directly. Contact numbers for the plans are
listed at the end of this section.
G. Current MassHealth Community-Based Services (in addition to the New Services)
The following are other community-based (e.g. non-24 hour) behavioral health services that are
available to youth enrolled in MassHealth. This is not meant to be an exhaustive list of available
benefits but an overview of behavioral health services that are available in addition to the new
MassHealth services described earlier in this document.
? Outpatient Behavioral Health Services: Outpatient services include individual, family,
and group therapies, as well as medication evaluation and monitoring. Outpatient services
can be provided in an office, clinic environment, a home, school, or other location.
Outpatient services can be used to treat a variety of behavioral health and/or substance
abuse issues that significantly interfere with functioning in at least one area of the youth’s
life (e.g., familial, social, occupational, educational). Outpatient is the least intensive level of
care available to youth.
? Community Support Programs (CSPs): Provide an array of services delivered by a
community-based, mobile, multidisciplinary team of paraprofessionals. CSP services are
appropriate for youth who have behavioral health issues challenging their optimal level of
functioning in the home/community setting. These services are designed to be maximally
flexible in supporting youth who are unable to independently access and sustain
involvement with needed services. Services may include: assisting youth in enhancing their
daily living skills; case management, skill building, developing a crisis plan; providing
prevention and intervention; and fostering empowerment and recovery, including linkages
to peer support and self-help groups. NOTE: As of October 1, 2009, CSP for youth under 18
will be replaced by the new community based behavioral health services, described earlier in this
document. Youth 18 through 20 will have access to both CSP services as well as the new
community based behavioral health services.
? Structured Outpatient Addiction Program (SOAP): SOAP is a short-term,
clinically intensive, structured day and/or evening substance abuse service. SOAP can be
used by youth, including pregnant youth, who need outpatient services, but who also need
more structured treatment for substance abuse. SOAPs provide multidisciplinary
treatment to address the sub-acute needs of youth with addiction and/or co-occurring
disorders, while allowing them to maintain participation in the community, continue to
work or attend school, and be part of family life.
? Partial Hospitalization Program is a nonresidential treatment program that may or
may not be hospital-based. The program provides clinical, diagnostic, and treatment
services on a level of intensity equal to an inpatient program, but on less than a 24-hour
basis. These services include therapeutic milieu, nursing, psychiatric evaluation and
medication management, group and individual/family therapy, psychological testing,
vocational counseling, rehabilitation recovery counseling, substance abuse evaluation and
counseling, and behavioral plans.
How Do I Make a Referral?
For more specific information about how to access these services on behalf of a youth enrolled in
a MassHealth managed care plan contact the plan directly.
To locate a provider for youth NOT enrolled in a MassHealth Managed Care Plan, please call:
MassHealth Customer Service 1-800-841-2900: TTY: 1-800-497-4648.
For youth who ARE enrolled in a MassHealth Managed Care Plan, please call:
? Boston Medical Center (BMC) HealthNet Plan 1-888-566-0010 (English and other
languages) 1-888-566-0012 (Spanish) TTY: 1-800-421-1220
? Fallon Community Health Plan 1-800-341-4848 TTY: 1-877-608-7677
? Health New England (HNE) 1-800-786-9999 (TTY: 1-800-439-2370)
? Neighborhood Health Plan 1-800-462-5449 TTY: 1-800-655-1761
? Network Health 1-888-257-1985 TTY: 617-888-391-5535
? Primary Care Clinician (PCC) Plan 1-800-841-2900 TTY: 1-800-497-4648
? Massachusetts Behavioral Health Partnership 1-800-495-0086 TTY: 617-790-4130
? Beacon Health Strategies 1888-217-3501 TTY:1-866-727-9441
Section 2
Department of
Public Health –
Early Intervention
Protocols
Strategic Opportunities for the Department of Public Health
and the Children’s Behavioral Health Initiative
The Massachusetts Department of Public Health (DPH) has a strong focus on child wellbeing
which requires incorporating a consideration of behavioral health into all of our child and youth
serving programs. We recognize that effective coordination between DPH and other behavioral
health programs and related agencies is a critical component to optimally serving children and
their families.
To that end, DPH seeks to be an active partner with other state agencies in the effort to
successfully implement the Children’s Behavioral Health Initiative (CHBI). DPH endorses the
following core principles as informing this partnership:
1. In its child and family serving programs, especially substance abuse services, school based
health centers and Early Intervention (EI) programs, DPH will work for a robust collaboration
with CHBI supported programs through:
? Seamless referrals to mental health providers.
? Integrated care planning, including discharge and transition planning, by substance abuse,
school-based health centers, EI programs and mental health providers. Any care plan
developed by one of these programs for a multiply involved child should be informed by
the participation of and/or consultation with the other involved services.
? Participation in the local systems of care committees.
2. DPH will promote collaborations between local community service agencies (CSA), substance
abuse service and EI providers, as well as school based health centers.
3. DPH is committed to training our staff and that of our sponsored programs on the newly
available behavioral health resources available through the Children’s Behavioral Health
Initiative to ensure optimal coordination. This training will include:
? Introduction to the goals of the integrated, wraparound model;
? Education about the protocols described in this document;
? Information on screening, assessment and referral resources available;
? A focus on collaborative care planning to ensure that roles, processes and expectations are
clear.
4. DPH shares the goal of minimizing disruptive transitions for families experiencing behavioral
health issues by having DPH sponsored programs provide information on the most appropriate
services available to a family based on their specific situation.
DPH is committed to supporting the successful implementation of the Children’s Behavioral
Health Initiative and will work to ensure that these protocols are integrated into the work of our
department and our supported agencies and programs.
C. Early Intervention
Overview
The Department of Public Health’s (DPH) Early Intervention (EI) is an integrated developmental
service available to families of children, between birth and three years of age, for whom there are
developmental concerns due to identified disabilities, or whose typical development is at risk due
to certain birth or environmental circumstances.
EI programs provide comprehensive integrated services, utilizing a family-centered approach to
facilitate the developmental progress of eligible children. EI services are designed to meet the
developmental needs of each child and the needs of the family related to enhancing the child’s
development. Services are provided by a team of professionals which may include developmental
specialists, physical therapists, speech-language pathologists, psychologists/mental health clinicians,
occupational therapists, social workers, nurses, and other specialty services providers.
1. Eligibility for MassHealth Behavioral Health Services
? If a youth (under age 21) is enrolled in MassHealth Standard or Commonhealth,
covered services include the new MassHealth behavioral health services, if the service is
medically necessary, as well as all other MassHealth-covered behavioral health services.
(Generally, about 85% of all youth enrolled in MassHealth have Standard or Commonhealth,
although enrollment statistics vary over time.)
? If a youth has MassHealth Family Assistance, Basic or Essential coverage types, the
youth may be eligible for Mobile Crisis intervention and In-Home Therapy, as well as many
other MassHealth Behavioral Health services. The other new MassHealth behavioral health
services, such as Intensive Care Coordination, are not covered services. The parents or
guardians should call MassHealth Customer Service for assistance. (The number is listed
below.)
? If a youth not enrolled in MassHealth Standard or CommonHealth has serious
emotional disturbance (SED) (as determined by through a CANS or other clinical
assessment) he or she may be eligible for CommonHealth, a MassHealth program for people
with disabilities. There is no income limit for CommonHealth. If the youth’s family’s income is
more than 100% of the federal poverty level, the family may have to pay a premium or pay a
one-time deductible. To apply for CommonHealth, parent/guardian should contact MassHealth
Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648), to request both a new “Medical
Benefits Request (MBR)” form, and a “Disability Supplement” form.
? If the youth or family/guardian does not know which type of MassHealth insurance
the youth has, staff can check the Eligibility Verification System (EVS) or help the family check
with their MassHealth Plan:
o Boston Medical Center (BMC) HealthNet Plan 1-888-566-0010 (English and other languages)
1-888-566-0012 (Spanish) TTY: 1-800-421-1220
o Fallon Community Health Plan 1-800-868-5200 TTY: 1-877-608-7677
o Health New England (HNE) 1-800-786-9999 (TTY: 1-800-439-2370)
o Neighborhood Health Plan 1-800-462-5449 TTY: 1-800-655-1761
o Network Health 1-888-257-1985 TTY: 617-888-391-5535
o Primary Care Clinician (PCC) Plan 1-800-841-2900 TTY: 1-800-497-4648
o Mass. Behavioral Health Partnership 1-800-495-0086 TTY: 617-790-4130
? If a family does not know which Health Plan their child is on, they can look at the
Health Plan card they give their doctor or nurse during an office visit. If they do not have a
card, they can call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648). If
they are enrolled in MassHealth, but not yet enrolled in a Health Plan, they can call MassHealth
customer service and be helped to enroll in a Health Plan.
? If the youth is not insured or has no coverage for mental health services, but may
be eligible for MassHealth, staff can help the youth/ parent/guardian contact the
appropriate regional MassHealth Enrollment Center, or call the MassHealth Customer Service
number. Again, if the child has serious emotional disturbance, the family should request a
disability supplement form, in addition to a Medical Benefits Form. (See above)
MassHealth Customer Service: 1-800-841-2900 (TTY:
1-800-497-4648)
MassHealth Regional Enrollment Centers
Revere
781-485-2500
Taunton
508-828-4600
Tewksbury
978-863-9200
Springfield
413-785-4100
? If the youth has private insurance, staff can help the youth/parent/guardian contact their
insurance company to access services covered by the insurer.
2. Identifying Children with BH Needs:
? When a primary care provider refers a child to EI as the result of a positive BH screen, the
EI program conducts a multidisciplinary team evaluation/assessment to determine eligibility
for EI services. If eligible, the EI team works with the child and family to develop an
Individualized Family Service Plan (IFSP).
3. Referrals for BH Assessment and Services
? If, through the Individualized Family Service Plan (IFSP) process and ongoing dialogue with
the family, the Service Coordinator or Early Intervention social worker, licensed mental
health counselor, or psychologist determine that additional assessment is needed, the
Service Coordinator will help the family access a comprehensive behavioral health
assessment including the CANS B-4. Given the scarcity of experienced infant/early
childhood mental health clinicians, Early Intervention’s network of social workers, licensed
mental health counselors, and psychologists may be a helpful resource to the Community
Service Agencies and other MassHealth Behavioral Health providers. In some situations,
the EI Service Coordinator may make an internal referral to a licensed mental health
clinician who is trained and authorized to complete the comprehensive behavioral health
assessment and the CANS B-4 on a child. These individuals may be able to bill MassHealth
for the administration of the CANS B-4 through their vendor agency or personal license.
? As part of the IFSP process, the EI Service Coordinator may develop an outcome and
specific strategies with the family to address the concern. EI staff can address minor
behavioral health issues (such as a child with a language delay who is biting) as part of the EI
service. The Service Coordinator may consult with additional team members, including an
EI Social Worker, Licensed Mental Health Counselor, or psychologist with expertise in the
area of concern for consultation or ongoing services as appropriate.
? If the team determines that the child and family may benefit from a clinically more intensive
service, such as In-home Therapy or Intensive Care Coordination, they will share
information with the child’s family about these MassHealth behavioral health services that
might be most appropriate to the needs of their child. Early Intervention providers can
help minimize the number of clinical transitions for the child and family by providing
information about the most appropriate service. EI providers can learn more about the
different services in the MassHealth Services section at the beginning of this manual, along
with more detailed Medical Necessity Criteria included in Appendix C.
? The EI Service Coordinator will assist the family in identifying the most appropriate
behavioral health provider with expertise in serving a B-3 population in their area. The EI
Service Coordinator will share appropriate information with the provider with parent
consent and following EI program information sharing protocols.
? The custodial parent or legal guardian has the right to seek behavioral health treatment,
including a pre-treatment assessment, from any provider of any service in the child’s
managed care network. If a family knows that they are interested in receiving Intensive
Care Coordination or In-home Therapy services, the family may go directly to a local
Community Service Agency for ICC or In-home Therapy provider to receive a behavioral
health assessment and determination of medical need for the service. (See Appendix A for
provider lists.
? If a child is in a psychiatric crisis, the parent/guardian or caregiver will be directed to
call for Mobile Crisis Intervention through their local Emergency Services Provider (ESP).
Mobile Crisis Intervention (MCI) will come to any location in the community where the
child or youth is located, including home, school or other community setting. MCI is a
short-term service that provides child-trained clinicians to respond to a youth experiencing
a behavioral health crisis. Teams assess, treat and stabilize the crisis situation, remaining
involved for up to 72 hours, including supporting the family by phone. MCI can also help
families access additional MassHealth behavioral health services for their child. (For more
information, see detailed service descriptions above and in Appendix C. See Appendix A
for provider contact information in your area.)
4. Expected Response to Referrals from EI to BH Services
? For Referrals to Intensive Care Coordination
o Within 24 hours of referral to ICC, the ICC provider will make telephone contact with
the parent or guardian to offer a face-to-face interview.
o A face-to-face interview with the youth and/or family will be offered within three (3)
calendar days of the referral to begin a comprehensive home-based assessment.
o The comprehensive home-based assessment must be completed within 10 calendar
days of the date on which consent for ICC was obtained. Eligibility for ICC services is
determined as part of the comprehensive home-based assessment.
o The ICC care coordinator is expected to contact the referring EI Service Coordinator
or SW, LMHC, or psychologist (with proper consent as required by law) to discuss the
referral before scheduling the comprehensive home-based assessment. As part of the
comprehensive home-based assessment, the ICC care coordinator is expected to
secure parent or guardian authorization and to convey it by fax, mail or hand delivery
to EI Service Coordinator or EI SW, LMHC, or psychologist (equivalent to CBHI
outpatient clinician) and the providers with whom they want to speak.
o The care coordinator will convene the youth’s Care Planning Team within 28 calendar
days of the parent/guardians consent to treatment.
? For Referrals to In-Home Therapy
o The In-Home Therapy provider responds telephonically to all referrals within one
business day.
o During daytime operating hours (8 a.m. to 8 p.m.), the In-Home Therapy Services
provider responds by offering a face-to-face meeting with the child or family seeking
services within 24 hours.
o In cases in which the In-Home Therapy provider has limited expertise in working
with the B-3 population, the EI SW, LMHC, or psychologist (equivalent to CBHI
outpatient clinician) will work closely with the team to ensure the child and family’s
needs are met. The EI program will support the In-Home provider in building its
capacity to work with children B-3.
? For Referrals to Mobile Crisis Intervention
o Mobile Crisis Intervention arrives within 1 hour of receiving a telephone request.
o For remote geographical areas, Mobile Crisis Intervention arrives within the usual
transport time to reach the destination.
5. Referrals to EI from BH Providers
BH providers identifying children B-3 with needs for Early Intervention should talk with the
family and, with their consent, make a referral to their local Early Intervention provider. A list
is located in Appendix D.
6. Continuity of Care
* Care Plan Integration:
? If the EI team helps the family to access BH services other than ICC, the behavioral
health service provider will participate in the development of the EI Individualized
Family Service Plan (IFSP). The EI Service Coordinator will incorporate all behavior
health service into the IFSP.
? In instances where the family determines that ICC is the most appropriate service
for a child age 0-3, the EI Service Coordinator or EI social worker, licensed mental
health counselor or psychologist will serve on the ICC Care Planning Team, with
the consent of the family.
? Establishing a Collaborative Relationship With The Local Community Service
Agency (CSA): The Director of the Early Intervention program will meet with the
director of the Community Service Agency (CSA) in their area to facilitate collaboration
for families served by both. If a Specialized CSA serving a specific target population is also
in the area, the EI Director should also establish a working relationship with the Specialized
CSA. For more on geographic and specialized CSAs, see Appendix A.
* Early Intervention Participation in Local System of Care Committees: Each
Community Service Agency will convene a Local System of Care Committee focused on
strengthening integration and communication among providers, families and other
stakeholders serving youth with significant behavioral health needs.
* The Director or designee will serve on the CSA’s Local System of Care Committee to
promote awareness of the behavioral health needs of 0-5 children and lead in the
coordination of care between EI services and behavioral health services.
7. Trainings To Ensure Coordination
* EI Staff Training: EI staff will receive training in these protocols and the CBHI service
system. The purpose of the Wraparound training is to understand the process of
collaborative care planning and the various roles in the process.
* CSA Training: Care coordinators and family partners will receive training in
collaborative approaches to working with Early Intervention programs. DPH staff will help
deliver this aspect of the CSA training.
These new services are expected to become available between June 30 and November 1, 2009. However, MassHealth
needs the approval of the federal Medicaid program in order to pay for these services. MassHealth has received
approval for Intensive Care Coordination and it awaiting approval for the other services.
22
Department of Public Health Guide to New and Current MassHealth Behavioral Health Services
October 2009 (EI)